Provider Demographics
NPI:1477654465
Name:RUDORFER, MATTHEW V (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:V
Last Name:RUDORFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11809 AMBLESIDE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2105
Mailing Address - Country:US
Mailing Address - Phone:301-424-5773
Mailing Address - Fax:301-424-5773
Practice Address - Street 1:6131 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3901
Practice Address - Country:US
Practice Address - Phone:301-424-5773
Practice Address - Fax:301-424-5773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-07-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD273352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93146Medicare UPIN